Feasibility and long-term efficacy of a proactive health program in the treatment of chronic back pain: a randomized controlled trial

被引:16
作者
Hueppe, A. [1 ]
Zeuner, C. [1 ]
Karstens, S. [2 ]
Hochheim, M. [3 ]
Wunderlich, M. [4 ]
Raspe, H. [5 ]
机构
[1] Univ Lubeck, Inst Social Med & Epidemiol, Ralzeburger Allee 160, D-23562 Lubeck, Germany
[2] Trier Univ Appl Sci, Dept Comp Sci, Therapeut Sci, D-54293 Trier, Germany
[3] Generali Hlth Solut GmbH, Hansaring 40-50, D-50670 Cologne, Germany
[4] Cent Krankenversicherung AG, Strateg Leistungs & Gesundheitsmanagement, Hansaring 40-50, D-50670 Cologne, Germany
[5] Univ Munster, Inst Eth Hist & Theory Med, Von Esmarch Str 62, D-48149 Munster, Germany
关键词
Back pain; Health services research; Evaluation; Patient-reported outcomes; CLINICALLY IMPORTANT DIFFERENCE; STATISTICS NOTES; PRIMARY-CARE; SCREENING TOOL; GLOBAL BURDEN; ZELEN DESIGN; MANAGEMENT; GUIDELINES; SEVERITY; CONSENT;
D O I
10.1186/s12913-019-4561-8
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background To facilitate access to evidence-based care for back pain, a German private medical insurance offered a health program proactively to their members. Feasibility and long-term efficacy of this approach were evaluated. Methods Using Zelen's design, adult members of the health insurance with chronic back pain according to billing data were randomized to the intervention (IG) or the control group (CG). Participants allocated to the IG were invited to participate in the comprehensive health program comprising medical exercise therapy and life style coaching, and those allocated to the CG to a longitudinal back pain survey. Primary outcomes were back pain severity (Korff's Chronic Pain Grade Questionnaire) as well as health-related quality of life (SF-12) assessed by identical online questionnaires at baseline and 2-year follow-up in both study arms. In addition to analyses of covariance, a subgroup analysis explored the heterogeneity of treatment effects among different risks of back pain chronification (STarT Back Tool). Results Out of 3462 persons selected, randomized and thereafter contacted, 552 agreed to participate. At the 24-month follow-up, data on 189 of 258 (73.3%) of the IG were available, in the CG on 255 of 294 (86.7%). Significant, small beneficial effects were seen in primary outcomes: Compared to the CG, the IG reported less disability (1.6 vs 2.0; p = 0.025; d = 0.24) and scored better at the SF-12 physical health scale (43.3 vs 41.0; p < 0.007; d = 0.26). No effect was seen in back pain intensity and in the SF-12 mental health scale. Persons with medium or high risk of back pain chronification at baseline responded better to the health program in all primary outcomes than the subgroup with low risk at baseline. Conclusions After 2 years, the proactive health program resulted in small positive long-term improvements. Using risk screening prior to inclusion in the health program might increase the percentage of participants deriving benefits from it.
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页数:13
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